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General NPI Number Information
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NPI Number | 1821107442
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Entity Type | Organization
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Legal Business Name | DRS ERIN AND RANDY ELLIOTT PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 120 CALLAWAY COURT
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City | BOWLING GREEN
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State | KY
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Zip | 42103
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Country | US
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Telephone | 270-782-0716
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Fax | 270-746-9603
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Provider Business Mailing Address
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Address Line | 120 CALLAWAY COURT
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City | BOWLING GREEN
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State | KY
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Zip | 42103
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Country | US
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Telephone | 270-782-0716
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Fax | 270-746-9603
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Authorized Official
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Title or Position | DOCTOR OWNER
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Name | DR. RANDY H ELLIOTT
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Credential | DMD
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Telephone | 270-782-0716
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 7232
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 7717
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License Number State | KY
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